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Longitudinal change in renal function in patients with idiopathic dilated cardiomyopathy without renal insufficiency
Komei Tanaka1, Masahiro Ito, Makoto Kodama
1Division of Cardiology, Department of Clinical Nephroscience, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Insights
Chronic heart failure patients without initial kidney problems often develop impaired renal function over time. Beta-blocker therapy may protect kidney function, while frequent hospitalizations and low blood pressure indicate a worse prognosis.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Impaired renal function is a known predictor of poor outcomes in chronic heart failure (CHF).
- Long-term renal function changes in CHF patients initially without renal insufficiency are not well understood.
Purpose of the Study:
- To investigate the long-term progression of renal function in patients with idiopathic dilated cardiomyopathy (IDCM) who initially had normal renal function.
- To identify predictors of developing renal insufficiency in this patient cohort.
Main Methods:
- Retrospective analysis of IDCM patients diagnosed between 1984 and 2003 with estimated creatinine clearance (eCcr) >= 60 ml/min.
- Kaplan-Meier method to calculate cumulative event proportions and renal insufficiency (eCcr < 60 ml/min).
- Logistic regression to identify predictors of renal insufficiency.
Main Results:
- Worsening renal function developed in 20% of patients within 8 years and 50% within 20 years.
- Predictors for renal insufficiency included advanced age at diagnosis, frequent hospital admissions, and hypotension.
- Beta-blocker therapy was found to be a negative predictor, suggesting a protective effect on renal function.
Conclusions:
- CHF patients with IDCM and normal baseline renal function are at risk for developing renal insufficiency over time.
- Frequent hospital admissions, hypotension, and absence of beta-blocker therapy are associated with a poorer renal function prognosis.
Background:
Impaired renal function is associated with poor outcomes among patients with chronic heart failure (CHF). However, the long-term changes in renal function in CHF patients without renal insufficiency at initial diagnosis remain unclear.
Methods And Results:
Retrospective analysis of patients presenting with idiopathic dilated cardiomyopathy (IDCM) from 1984 to 2003 and who had normal renal function defined as estimated creatinine clearance (eCcr)>or=60 ml/min at the first diagnosis. Cumulative event proportions and renal insufficiency defined as eCcr<60 ml/min were calculated by the Kaplan-Meier method. The predictors of renal insufficiency were evaluated by logistic regression analysis. Impaired renal function developed in 20% during an 8-year follow-up and in 50% during a 20-year follow-up. Advanced age at the first diagnosis, high frequency of admissions, and hypotension during the clinical course were associated with the occurrence of impaired renal function. Beta-blocker therapy was a negative predictor of renal insufficiency.
Conclusions:
In patients with IDCM without renal insufficiency at initial diagnosis, worsening renal function occurred during the follow-up period. Frequent admissions, hypotension, and lacking beta-blocker therapy were associated with a poor prognosis in renal function.
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